Provider Demographics
NPI:1710484266
Name:FITZPATRICK, OLIVIA ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ELIZABETH
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 OLD STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:GLENFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12433-5019
Mailing Address - Country:US
Mailing Address - Phone:845-657-8736
Mailing Address - Fax:
Practice Address - Street 1:5 BOCES ROAD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-486-4800
Practice Address - Fax:845-486-4981
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022196-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist